Twin Anemia Polycythemia Sequence: Pretreatment Characteristics and Outcomes Stratified by Management Approach

OBJECTIVE: To compare Twin Anemia Polycythemia Sequence (TAPS) cases by treatment modality. METHODS: Single-center, retrospective review of TAPS without Twin to Twin Transfusion Syndrome undergoing expectant management (EM), intrauterine transfusion +/- partial exchange transfusion (IUT/pET), fetoscopic laser surgery (FLS), or selective fetal reduction (SFR). RESULTS: In 52 TAPS cases, 36 (69%) were spontaneous and 16 (31%) postlaser. 15 (29%) underwent EM, 9 (17%) IUT/pET, 22 (42%) FLS, and 6 (12%) SFR. FLS and SFR groups had higher median middle cerebral artery (MCA) discordance (p = 0.007). IUT/pET had later median gestational age (GA) at diagnosis (weeks): 20.9 for FLS, 18.0 for SFR, 21.4 for EM, and 25.6 for IUT/pET (p = 0.001). FLS was associated with isolated polyhydramnios (p = 0.027), and SFR with isolated oligohydramnios (p = 0.005). Treatment to delivery interval (weeks) was 5.4 for IUT/pET, 11.0 for FLS, and 20.6 for SFR (p < 0.001). Median GA at delivery was latest in SFR (p = 0.003). Perinatal survival for EM, IUT/pET, FLS and SFR was 93.3%, 94.4%, 87.5%, and 50%, respectively. CONCLUSION: Gestational age, fluid abnormalities, and MCA discordance differed across treatment groups. Placentation, TAPS etiology, and coexisting sFGR were more evenly distributed across management strategies indicating they were less influential factors in management decisions. Outcomes were overall favorable and did not differ across management groups.